Statins, Their Importance, and You
If you’ve been reading this monthly newsletter, you know certain Clinical Guidelines are encouraged across all health plans. Providers participating in value-based contracts are held to these performance metrics as a way to objectively evaluate the quality of care they provide members. One such metric is Statin Use in Persons with Cardiovascular Disease (SPC).
Who falls into this metric? Males ages 21-75 and females ages 40-75 with a diagnosis of coronary artery disease, peripheral vascular disease, or any other diagnosis of vascular disease, including aortic atherosclerosis.
What is the expectation? These individuals should be taking a statin of moderate to high dose (see Statin Use Measures reference for a list of medications and doses that qualify.)
Are there exclusions? Yes, members who have certain diagnoses, including myalgias and myositis, cirrhosis of the liver, end-stage renal disease, and females who are pregnant or who undergo in vitro fertilization in the measurement year are excluded. To be counted as an exclusion, the member must have the exclusionary diagnosis submitted on a claim to the insurance plan during that same measurement year.
Why is this so important? Vascular disease, in all its forms, is one of the tops killers in this country. Statins have been shown to decrease the burden of vascular disease in individuals.
But what if the member does not have high cholesterol? The metric is irrespective of baseline cholesterol. Having a low-density lipoprotein (LDL cholesterol) of under 70 does not exclude a member from the metric. Why not? Remember that cholesterol target numbers are just surrogate markers. Statins do more than just lower LDL cholesterol. There is a pleiotropic effect of taking a statin that decreases intravascular inflammation, a separate mechanism for the reduction of risk in these members. Besides, that plaque got into their arteries somehow, right?
What do you do in the case of someone intolerant of statins? Have you heard of the nocebo effect? This is a situation where negative outcomes occur due to a belief that an intervention will cause harm. It is the embodiment of the self-fulfilling prophecy. An individual can actually talk themselves into having a side effect of a statin. In my practice, I avoid this by starting a leery member out on a statin slowly, with once or twice weekly dosing, and gradually increase it from there, as the member sees no ill effects occurring. Twenty milligrams (20mg) of rosuvastatin once weekly is considered high dose statin therapy and will close the metric, provide protection to the member, and chip away at any nocebo effect along the way.
Why should I go to all this trouble? Because it is what we do.
Dr. Beth Hodges is a family practice and palliative care/hospice physician in Asheboro, N.C., as well as a part-time medical director for HealthTeam Advantage.